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A child with acute lymphocytic leukemia developed a sinus clot, mimicking central nervous system leukemia symptoms. This complication may be more common than recognized, especially when spinal fluid tests are normal.
Area of Science:
- Pediatric Oncology
- Neurology
- Hematology
Background:
- Acute lymphocytic leukemia (ALL) can infiltrate the central nervous system (CNS).
- Cerebral spinal fluid (CSF) pleocytosis typically indicates CNS leukemia.
- Superior sagittal sinus thrombosis (SST) is a rare but serious complication.
Observation:
- A 7-year-old child with relapsed ALL developed SST.
- The patient presented without the usual CSF pleocytosis.
- Angiography and post-mortem examination confirmed the SST.
Findings:
- Absence of CSF pleocytosis can mask CNS leukemia.
- SST may mimic CNS leukemia signs and symptoms.
- SST might be an underdiagnosed complication of ALL.
Implications:
- Standard CNS leukemia therapies may be inappropriate if SST is present without pleocytosis.
- Increased awareness of SST in ALL patients, particularly those without CSF pleocytosis, is crucial.
- Further research is needed to understand the incidence and management of SST in ALL.
Abstract:
The case of a 7-year-old child with acute lymphocytic leukemia who, while in relapse, developed a superior sagittal sinus thrombosis is documented by angiography and post-mortem examination. Review of the literature suggests that cerebral spinal fluid (CSF) pleocytosis which usually accompanies the arachnoid infiltration of central nervous system (CNS) leukemia may be absent in some patients as in this case. In the absence of CSF pleocytosis, cerebral venous sinus thrombosis may mimic the other signs and symptoms of CNS leukemia and consequently may be a more frequent complication of acute leukemia than is presently appreciated. Therapy directed to the CSF axis generally would not under these circumstances be appropriate.